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PERMIT FIELD CHECKLIST <br />PMN gg6qM S% LOCATION: 92i N ArA Avt S4'/✓k-i-pn SUBMITTED BY: AIM _ DATE:joaa- <br />PERMIT FOR: NBC] G4ED EMERGE] LK® (GRADE): � CORROSION❑ OTHER: <br />IF EMERGENCY, IS WORK COMPLETED ALREADY? YESD NOD (DATE)? <br />• AGENCY (CITYD COUNTYD1 CALTRANSE] OTHER[]): <br />• DIMENSIONS FOR EXCAVATION (W x Lx D): + . W <br />• ASPHALT❑ CONCRETED BOTH69 NO PAVING❑ <br />• SIDEWALK CLOSURE REQUIRED? YES❑ NOIia <br />• BIKE LANE CLOSURE REQUIRED? YESO NOIO <br />• STREET CLOSURE REQUIRED? YESO NOM <br />• LANE CLOSURE REQUIRED? YESKI NOD <br />• PARKING CLOSURE REQUIRED? YES❑ NO1W <br />• ANY RESTRIPING REQUIRED? YESO NOtC <br />• TRAFFIC SIGNAL LOOP INVOLVED? YESO NO® <br />• "NO PARKING" SIGNS NEEDED? YESE NOD <br />• OTHER TRAFFIC IMPACTS? <br />• OTHER COMMENTS? <br />LOCATION (INCLUDE DIMENSIONS FROM PROPERTY LINE, NEAREST CROSS STREET, CURB OR LANDMARKS) <br />E. AAiMr Ade, <br />%V <br />